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102 Cards in this Set
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Achondroplasia key features
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champagne glass pelvis
Altered femur neck angle (genu varum/genu valgum) narrow interpedicular distance central canal stenosis: leads to posterior scalloping of the veterbra. is the most common cause of death in achondroplasia bullet nose vertebra: no ring apophysis Rhizomelia: Short root, long bones are short in achondroplasia Small Foramen Magnum: often kills @ time of birth if having achondroplasia |
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what type of deformity is this?
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champagne glass pevis: anteverted pelvis, squared off ilia, low ASIS, high PSIS
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what is this deformity
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Genu Varum which, along with genu valgum, are common in achondroplasia
Genu Valgum = >130 degrees genu varum = <120 degrees |
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what is this deformity?
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decreased interpedicular distance common in achondroplasia
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what is this deformity?
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posterior scalloping of the vertebra, common in achondroplaisa.
CSF flow causes dural ectasia ***most common cause of death in adults w/ achondroplasia***** |
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what is this deformity?
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Bullet nose vertebra, common in achondroplasia
no ring apophysis, corner of the vertebra is missing |
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what is Rhizomelia?
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Short root: long bones are shortened. common achondroplasia, OI, and spondyloepiphyseal dysplasia
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what deformity does this child have?
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cleidocranial dysplasis, she has no colllar bone
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what is this deformity?
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cleidocranial dysplasia: no collar bone present in 10%, usually malformed
can show midline defects such as cleft palate w/ hair lip and wormian bones in the cranial vault. may be missing pubic symphysis may have spina bifida occulta funnel shaped chest altered craniofacial ratio: more cranium than face |
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what is this deformity?
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cleidocranial dysplasia of the pelvis: missing pubic symphysis and DJD of SI joint present
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what is this deformity
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Arachnodactyly (spider fingers), common in Marfan syndrome: affects hands and feet
Show positive thumb sign: distal phalanx of 1st digit sticks out past 5th when a fist is made Also shows dislocation of eyeballs, aortic complications pectus excavatum (sunken chest, left deviation of heart) |
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what is this deformity
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osteopterosis: Sclerosing dysplasia & brittle bone disease
"Chalk Bone" Fetal bone is not replaced, adult bone builds around it is very white on x-ray and easily broken also shows sandwich vertebra/ rugger jersey spine: disc space shows as black band, endplates are white bands and dark band in middle of each vertebra |
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forms of osteopetrosis
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Congenital and tarda: both show anemia, due to lack of marrow along with insufficiency fractures
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what is this deformity
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Osteogenesis imperfecta: shows exuberant callous formation due to brittle bones: narrow bones due to undertubularization
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osteogenesis imperfecta features:
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brittle bone disease
can show arachnodactyly or brachidactyly exuberant callous formation 2 forms: congenital and tarda can show a little as 10% cortex in bone structure Blue sclera is common feature |
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what is this deformity
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Apert's shows short skull: small cranial-facial ratio
other features: mitten hand, right angle b/t 1st phalanx and metacarpal |
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features of Apert's
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Mitten hands
short skulls small cranial-facial ratio may show scaphocephaly due to early closure of mid sagittal sutures |
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what condition is this deformity associated with
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Apert's mitten hand. only a soft tissue fissure b/t 4th and 5th digits
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what is this deformity
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osteopoikilosis: sclerosing dysplasia
shows islands of cortical bone @ end of the bone--near joint spaces no increases osteoblastic activity no negative pathology in the joint |
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what is this deformity
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trichirhinophalangeal: shows coarse brittle hair, bulbous nose, small underdeveloped phalanges
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what is this deformity
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trichirhiophalangeal: shows coarse brittle hair, bulbous nose, small underdeveloped phalanges
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chirolumbardysostosis
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Can't line up 3rd, 4th, 5th metacarpals
distal phalanges are smaller than usual posterior scalloping or spina bifida occulta |
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what is this deformity
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stippled epiphysis: fragmentation of primary ossification center
looks like polka dots |
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what is this deformity
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spondyloepiphyseal dysplasia: flattened femur head, irregular contour
acetabular depth below normal subchondral cysts in acetabulum hump shaped / heaped up vertebra: hump is in normal POC, no ring apophysis on vertebral body--makes sharp corners |
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what is this deformity
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cranial vertebral synostosis, or occipitalization
C1 united w/ occiput leads to narrowing of central canal often shows corticated hole b/t C1 and occiput |
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what is this deformity
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blocked vertebrae: multiple fused vertebra
no movement due to fused posterior arch. occurs at somite stage take flexion-extension views to look for canal narrowing |
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what is this deformity
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agenesis of the posterior tubercle of C1:
can't see spinolaminar line on C1 non-fusion of posterior tubercle looks like spina bifida occulta very large anterior tubercle --is a stress response people with this deformity should not play contact sports |
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what is this deformity
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agenesis of the posterior tubercle of C1:
can't see spinolaminar line on C1 non-fusion of posterior tubercle looks like spina bifida occulta very large anterior tubercle --is a stress response people with this deformity should not play contact sports |
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what is this deformity
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agenesis of the posterior tubercle of C1:
can't see spinolaminar line on C1 non-fusion of posterior tubercle looks like spina bifida occulta very large anterior tubercle --is a stress response people with this deformity should not play contact sports |
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what is this deformity
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agenesis of the posterior tubercle of C1:
can't see spinolaminar line on C1 non-fusion of posterior tubercle looks like spina bifida occulta very large anterior tubercle --is a stress response people with this deformity should not play contact sports |
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agenesis of posterior tubercle of C1
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non-fusion of posterior arch, looks like spina bifida occulta
very large anterior tubercle--due to stress response axial loading is very dangerous for them |
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what is this deformity
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Spina bifida occulta: least significant form of spina bifida
non union of posterior arch of vertebra |
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what is this deformity
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arcuate foramen, AKA posterior ponticle
atlanto axial ligament involved biggest issue is vertebro-basilar insufficiency |
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categories of soft tissue calficication
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1. physiologic
2. dystrophic 3. metastatic |
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what picks up calcium better than chondral matrix
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osteoid
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what is this deformity
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os odontoideum: odontoid process of C2 is not attached to the body
free movement in extension non-union fracture requiring stabilization surgery |
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what is this deformity
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os odontoideum: odontoid process of C2 is not attached to the body
free movement in extension non-union fracture requiring stabilization surgery |
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ununited growth center
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looks like fracture at spinolaminar junction
can also appear as ant. tubercle vert. split into 2 pieces growth center divided into 2 pieces |
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what is this deformity
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hyperostosis internus (frontalis):
too much bone in the walls of the cranial vault no diploic space brain figures out how to work with less space normal function |
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what is this deformity
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hyperostosis internus (frontalis):
too much bone in the walls of the cranial vault no diploic space brain figures out how to work with less space normal function |
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what is this deformity
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parietal foramen: appears as bilateral symmetrical holes in the skull (black circles)
appears as mastoid air cells on lateral view can feel pulse through the holes, are developmental |
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features of block vertebrae
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failure of separation at somite level
Wasp Waste Appearance: narrow in the middle, white line in the middle is called a joint scar where the disc would be motion increases above and below this segment DJD appears above and below |
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other types of block vertebrae
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acquired: from surgery, most difficult to tell apart from congenital
infection: can breakthrough endplate and kill the disc= merger of bodies arthritis: often w/ autoimmune conditions |
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Major concern w/ block vertebrae
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ADI instability: need flexion extension views, see if transverse ligament is damaged
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physiologic calcification possibilities
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arcuate foramen
enlarged thyroid cartilage styloid-hyoid ligament |
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what is seen on lateral view w/ os odontoideum
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anterior body line, posterior body line & facet line are normal , but spinolaminar line is wrong
worry if odontoid is tipped forward when drawing axis line |
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what is spondyloschisis
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midline defect
2 gaps: where Ant. & Post. tubercles should be capsular and transvers ligaments is all that is holding them together |
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developmental cleft
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override of cortical margins w/ parallel endplates
longus collie hypertrophy not clinically significant |
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cervical rib
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C7 rib
can have accessory articulation AKA cervical digit can occur unilaterally or bilaterally |
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x-rays features of Os Odontoideum
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good anterior body line
good posterior body line posterior facet line is good spinolaminar line disrupted anterior tubercle too far forward --decreased ADI --no room for cord is a concern w/ Down's syndrome Pts. often don't have transverse ligament |
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dysplastic posterior elements
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multiple level of post. element= unusual
post. & ant. body line= OK spinolaminar line = not present small ant. tubercle @ C1 flexion & extension views: ant. & post. body lines look good |
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scrambled spine characteristics
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group of hemi vertebra
produces structural scoliosis multiple vertebra have 3 pedicles instead of 2 |
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what is this deformity
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sprengel deformity: unilateral elevation of the scapula
clavicle elevated common to see omovertebral bone (spine to spine bone bar) from C-spine to cervicothoracic jct. limited shoulder movement |
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what is this deformity
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klippel feil syndrome:
multilpe block vertebra typically shows prominent trap, pterygium coli 45% also have sprengels deformity w/ omovertebral bone |
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costochondral calcification
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part of physiologic calcification
appears as speckled white spots on the ribs |
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straight back syndrome
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3 components:
-loss of thoracic kyphosis -reduced A-P diameter -cardiac abnormality / murmur can't see right side of the heart classically shows pectus excavatum |
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what is this?
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limbus deformity: acquired deformity due to axial load
nucleus pulposus goes through the endplate of an immature vertebra Schmorls node punched through an endplate NP displaces ring apophysis which doesn't enable it to grow |
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what is the deformity
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hypoplasia of lumbar pedicle:
missing lumbar pedicle: lytic mets is # 1 cause large/ overgrown pedicle on opposite side due to stress hypertrophy |
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spondylolysis
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pars fracture from repetitive injury
ex. L5 anterior to the sacrum Test with: -percentage method -myerding's -Allman''s -George's posterior body line use flexion and extension films spondylolisthesis affects 7% of the population |
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Wiltse Classification of Spondylolisthesis.....Type 1
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Type I: Dysplastic: rare type, congenital abnormality in the upper sacrum or the neural arch of L5 that allows displacement to occur
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Wiltse Classification of Spondylolisthesis....Type 2
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Type II: isthmic: 2 subtypes w/ alteration to the pars.
1) lytic or stress fracture of the pars ---elongated but intact pars ---acute pars fracture |
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Wiltse Classification of Spondylolisthesis....Type 3
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Degenerative (psuedospondylolisthesis)
---is secondary to long standing degenerative arthrosis of z-joints and discovertebral articulations w/o a pars separation 2nd most common type: only goes about 25 deg. anterior |
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Wiltse Classification of Spondylolisthesis....Type 4
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Traumatic: secondary to fracture of part of the neural arch other than the pars
---verterbra is shattered, resulting in anterior translation |
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Wiltse Classification of Spondylolisthesis.....Type 5
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pathologic: occurs due to generalized or localized bone disease (Paget's, metatastic bone disease, osteoporosis
---Pagets is associated with osteomalacia ----Mets may have a missing pedicle |
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how much translation before a spondylo becomes unstable
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>3mm
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what types of radiographs are done for spondylolisthesis?
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distraction (hanging)
compression (Hanging with weight) can also use SPECT and MRI |
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Types 1A sacralization
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Asymetrical
1TP greater than 19 mm |
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Type 1B
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Bilateral
2 TP's greater than 19mm |
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Type 2A sacralization
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called and accessory joint
unilateral accessory joint and a TP ***the most clinically significant*** 80% rate of herniation of NP Function of NP compromised due to thinner annular fibers abnormal and asymetric motion need to modify how Pt gets adjusted |
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Type 2B sacaralization
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bilateral accessory joint
2nd most clinically significant 47% herniation rate of NP |
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Type 3A sacralization
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partial sacralization
1TP merged w/ sacrum forming a bone bar bone bar protects disc= 0% herniation rate of NP is a block vertebra configuration can not adjust here |
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Type 3B sacralization
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bilateral bone bars
0% herniation at transitional segment may have joint scar do not adjust here |
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Type 4 sacrailization
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hybrid segment
pseudo joint on one side and bone bar on another Bone bar protects transitional segment so 0% herniation rate can't adjust here can become 3B due to lack of motion |
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S2 hypertrophy
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Overgrown S2 Spinous
on x-ray, L5 spinous may touch S2 congenital defect disc is compromised may be locally painful |
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what is this deformity
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knife clasp deformity: bone is missing in midline of sacrum
elongated L5 spinous is a divot in the sacrum can cause complications/injury on extension can cause local and leg pain |
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what is this deformity
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knife clasp deformity: bone is missing in midline of sacrum
elongated L5 spinous is a divot in the sacrum can cause complications/injury on extension can cause local and leg pain |
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what is this deformity
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clasp knife deformity: bone is missing in midline of sacrum
elongated L5 spinous is a divot in the sacrum can cause complications/injury on extension can cause local and leg pain |
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pterygium Coli is?
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Web Neck due to a prominent trapezius muscle. this is very common in Klippel Feil Syndrome
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what is this deformity
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supracondylar process of humerus: often has ligament that crossed the elbow called ligament of struthers
--can produce neurovascular compression can present similar to an osteochondroma ---cartilage portion is always at the tip of the bone and points away from the joint ---or will only be bony & point toward the joint (elbow) if supracondylar |
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what is a concern with a supracondylar process of the humerus
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fracture, it is easy to break since it sticks out
will not immoblize |
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what is the deformity
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Bilateral Coxa Valga
the femur angle on both sides is > 130 degrees can only call it coxa valga if the Pt is skeletally mature (growth plate closed) otherwise it may yet return to normal angle typically decreases as we skeletally mature **** important to note that the number can never get bigger, if cox vara as a child, then will always have coxa vara |
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what is the deformity
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fabella: always found on lateral head of gastrocnemius
--is extracapsular, is found behind the joint capsule differential is for a joint mouse which is an intracapsular phenomenon ---may have clicking in the joint ---look for joint locking ---typically resides in intracondylar notch |
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what is the deformity
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biparate sesamoid bone: on the 1st metatarsal
--can be confused w/ a fracture --crushing of sesamoid can lead to AVN |
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what is this deformity
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polydactyly: notice the extra digit
looks like a rectangular portion of bone w/ a pointy end found lateral to 5th metatarsal on foot found b/t thumb and index finger on hand |
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what is this deformity
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os peroneus: typical on peroneus brevis short head
proximal to styloid process distal to calcaneus is a bipartate accessory ossicle differential is calcific tendonitits -- has multiple inversion injuries of the tendon w/ changed local pH allowing Ca++ to proliferate |
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what is this deformity
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Madelung's deformity: AKA bayonet wrist on the lateral view
should normally be able to draw 3 arcs to assess metacarpal but cannot articular surface of wrist looks like a letter V due to location of radius and ulna on A-P view ---they are not in the same plane |
choices for differential are:
Madelung's deformity Ulna minus Fracture |
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what is this deformity
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Ulna minus: ulna does not participate in the articulation of the wrist
*** has high rate of scapholunar dislocation (terry thomas sign)******** |
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bilateral synostosis
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3rd digit w/o PIP joint
looks like a bone bar distal to MP joint is congenital |
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what is this deformity
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sacral agenesis: no sacrum is visible, L5 is between the ilia
patient is forced into anterior weight bearing |
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what is this deformity
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ossified iliolumbar ligament:
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what is the deformity
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cupids bow sign:
notochordal persistency occurs bilaterally symmetrical puncture shows 2 curves On CT will appear to be eyes on VB Cortical rim of VB is hypertrophied showing that it is carrying a substantial load may see added cortical bone at L4 NP has gone thru growth ring (limbus vertebra) and is connected to L5 and loaded as bearing weight from joint above not likely to be a schmorls node |
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what is the deformity if the acetabulum
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hypoplasia of the acetabulum:
is too small center edge line: shows femur head sticking out of acetabulum giving a larger width therefore affecting line Acetabular depth line affected iliolumbar line affected shenton's line affected --will see mottling of femur head due to premature DJD ----added weight on smaller area ---increased risk of dislocation is congenital |
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what is wrong with this pelvis
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hypoplasia of the hemipelvis:
one side is smaller than the other --will be a gait abnormality ---patella at an angle on affected side ---pubic body is small on affected side, leads to abnormal joint relationship |
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what is pubic symphysis synostosis
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pubic symphysis is not formed properly
is a bone bridge crossing the symphysis does not allow for normal eccentric rotation of the ilium. sacrum rocks back and forth instead of nutating & counter-nutating |
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what is hypoplastic patella
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the patella is not completely formed
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what is hypoplastic talus
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the tibia appears too close to the foot because the talus is not completely developed
***may see rocker bottom foot*** ---big toe located under 2nd toes |
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synostosis of the 4th metatarsal
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bone bridging gap between the metatarsals and tarsals
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ununited growth center of distal head of the clavicle
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leads to AC DJD
cortical bone is surrounding bone pieces which rule out fracture |
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hypoplastic 5th metacarpal
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5th metacarpal is shorter than the others
Pt. can't make a fist with a smooth curve (5th knuckle is lower than the others) |
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lordotic sacrum
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sacrum has a lordosis instead of a kyphosis
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agenesis of the pedicle
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L5 is not attached to the sacrum
One pedicle is missing from L5 and there is an increase in weight bearing on the opposite side facets on the sacrum and L5 |
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what is this deformity
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bullet nose vertebra which is common in achondroplasia
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